Seniors with more vitamin D are less light-headed (Orthostatic Hypotension) - many studies

Orthostatic hypotension 1.36 X more likely if low vitamin D – meta-analysis Oct 2021

Orthostatic hypotension and vitamin D deficiency in older adults: systematic review and meta-analysis
Aging Clin Exp Res doi: 10.1007/s40520-021-01994-w

Marco Zuin 1, Gloria Brombo 2, Eleonora Capatti 2, Tommaso Romagnoli 2, Giovanni Zuliani 2

Background: Over the latest years different studies have investigated the possible relationship between D deficiency and occurrence of orthostatic hypotension (OH), often reaching controversial results. We perform an update meta-analysis providing an update overview on the association between hypovitaminosis D and orthostatic hypotension (OH) in older adults.
Methods: Data extraction was independently performed by two authors and based upon predefined criteria. The meta-analysis was performed using a random-effects model. Statistical heterogeneity between groups was measured using the Higgins I2 statistic.

Results: Eight investigations enrolling 16.326 patients (mean age 75.5 years) met the inclusion criteria and were considered for the analysis. Patients with vitamin D deficiency were more likely to have OH compared to those without (OR: 1.36, 95% CI 1.14-1.63, p = 0.0001, I2 = 43.6%). A further sub-analysis, based on three studies, estimating the risk of OH in patients with hypovitaminosis D receiving antihypertensive treatment, did not reach the statistical significance (OR: 1.40, 95% CI 0.61-3.18, p = 0.418, I2 = 53.3%). Meta-regression performed using age (p = 0.12), BMI (p = 0.73) and gender (p = 0.62) as moderators did not reveal any statistical significance in influencing OH. Conversely, physical activity, Vitamin D supplementation and use of radioimmunoassay for the measurement of vitamin D serum levels showed a significant inverse relationship towards the risk of OH (Coeff.-0.09, p = 0.002, Coeff. - 0.12, p < 0.001 and Coeff. - 0.08, p = 0.03, respectively) among patients with hypovitaminosis D. A direct correlation between the administration of antihypertensive treatment and the risk of OH in older patients with low vitamin D level was observed (Coeff. 0.05, p < 0.001).

Conclusions: Hypovitaminosis D is significantly associated with OH in older adults and directly influence by the administration of antihypertensive drugs. Conversely, physical activity, vitamin D supplementation and use of radioimmunoassay as analytic method inversely correlated with the risk of OH in older patients.
References

  1. Low PA (2008) Prevalence of orthostatic hypotension. Clin Auton Res 18:8–13 - DOI
  2. Gupta V, Lipsitz LA (2007) Orthostatic hypotension in the elderly: diagnosis and treatment. Am J Med 120:841–847 - DOI
  3. Peel NM (2011) Epidemiology of falls in older age. Can J Aging 30:7–19. https://doi.org/10.1017/S071498081000070X - DOI - PubMed
  4. Alekna V, Stukas R, Tamulaitytė-Morozovienė I et al (2015) Self reported consequences and healthcare costs of falls among elderly women. Medicina 51:57–62 - DOI
  5. Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB et al (2009) Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials. BMJ 339:3692 - DOI
  6. Ometto F, Stubbs B, Annweiler C et al (2016) Hypovitaminosis D and orthostatic hypotension: a systematic review and meta-analysis. J Hypertens 34:1036–1043 - DOI
  7. Moher D, Liberati A, Tetzlaff J et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097 - DOI
  8. Gilani A, Ramsay SE, Welsh P et al (2021) Vitamin D deficiency is associated with orthostatic hypotension in older men: a cross-sectional analysis from the British Regional Heart Study. Age Ageing 50:198–204. https://doi.org/10.1093/ageing/afaa146 - DOI - PubMed
  9. Laird EJ, McNicholas T, O’Halloran AM et al (2019) Vitamin D status is not associated with orthostatic hypotension in older adults. Hypertension 74:639–644. https://doi.org/10.1161/HYPERTENSIONAHA.119.13064 - DOI - PubMed
  10. Veronese N, Trevisan C, Bolzetta F et al (2016) Hypovitaminosis D predicts the onset of orthostatic hypotension in older adults. J Am Soc Hypertens 10:724–732. https://doi.org/10.1016/j.jash.2016.06.038 - DOI - PubMed
  11. Duval GT, Brangier A, Barré J et al (2015) Vitamin D deficiency and incident onset of orthostatic hypotension in older adults: preliminary results from the ‘MERE’ study. J Am Geriatr Soc 63:1245–1247. https://doi.org/10.1111/jgs.13504 - DOI - PubMed
  12. Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy (1996) The consensus committee of the American autonomic society and the American academy of neurology. Neurology 46:1470. https://doi.org/10.1212/wnl.46.5.1470 - DOI
  13. Soysal P, Yay A, Isik AT (2014) Does vitamin D deficiency increase orthostatic hypotension risk in the elderly patients? Arch Gerontol Geriatr 59:74–77 - DOI
  14. Annweiler C, Schott AM, Rolland Y et al (2014) Vitamin D deficiency is associated with orthostatic hypotension in oldest-old women. J Intern Med 276:285–295 - DOI
  15. Veronese N, Bolzetta F, De Rui M et al (2014) Serum 25-hydroxyvitamin D and orthostatic hypotension in old people: the Pro.V.A. study. Hypertension 64:481–486 - DOI
  16. McCarroll KG, Robinson DJ, Coughlan A et al (2012) Vitamin D and orthostatic hypotension. Age Ageing 41:810–813 - DOI
  17. Aronow WS, Fleg JL, Pepine CJ et al (2011) ACCF/AHA 2011 expert consensus document on hypertension in the elderly: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. Circulation 123:2434–2506. https://doi.org/10.1161/CIR.0b013e31821daaf6 - DOI - PubMed
  18. Applegate WB, Davis BR, Black HR et al (1991) Prevalence of postural hypotension at baseline in the systolic hypertension in the elderly program (SHEP) cohort. J Am Geriatr Soc 39:1057–1064 - DOI
  19. Beckett NS, Peters R, Fletcher AE et al (2008) Treatment of hypertension in patients 80 years of age or older. N Engl J Med 358:1887–1898 - DOI
  20. Valbusa F, Labat C, Salvi P et al (2012) Orthostatic hypotension in very old subject living in nursing homes: the PARTAGE study. J Hypertens 30:53–60 - DOI
  21. Liguori I, Russo G, Coscia V et al (2018) Orthostatic Hypotension in the elderly: a marker of clinical frailty? J Am Med Dir Assoc 19:779–785 - DOI
  22. Annweiler C, Souberbielle JC, Schott AM et al (2011) Vitamin D in the elderly: 5 points to remember. Geriatr Psychol Neuropsychiatr Vieil 9:259–267 - PubMed
  23. Li YC, Kong J, Wei M et al (2002) 1,25-Dihydroxyvitamin D3 is a negative endocrine regulator of the renin—angiotensin system. J Clin Invest 110:229–238 - DOI
  24. Forman JP, Williams JS, Fisher ND et al (2010) Plasma 25-hydroxyvitamin D and regulation of the renin-angiotensin system in humans. Hypertension 55:1283–1288 - DOI
  25. Harris RA, Pederson-White J, Guo DH et al (2011) Vitamin D(3) supplementation for 16 weeks improves flow-mediated dilation in overweight African-American adults. Am J Hypertens 24:557–562 - DOI
  26. Ni W, Watts SW, Ng M et al (2014) Elimination of vitamin D receptor in vascular endothelial cells alters vascular function. Hypertension 64:1290–1298 - DOI
  27. Sugden JA, Davies JI, Witham MD et al (2008) Vitamin D improves endothelial function in patients with Type 2 diabetes mellitus and low vitamin D levels. Diabet Med 25:320–325 - DOI
  28. Meehan M, Penckofer S (2014) The role of vitamin D in the aging adult. J Aging Gerontol 2:60–71. https://doi.org/10.12974/2309-6128.2014.02.02.1 - DOI - PubMed - PMC
  29. Carter GD (2011) Accuracy of 25-hydroxyvitamin D assays: confronting the issues. Curr Drug Targets 12:19–28. https://doi.org/10.2174/138945011793591608 - DOI - PubMed

Hypotention 3.4 X more likely if low vitamin D – June 2016

Factors associated with orthostatic hypotension in hospitalized elderly patients - June 2016
Aging Clin Exp Res. 2016 Jun;28(3):513-7. doi: 10.1007/s40520-015-0451-z. Epub 2015 Oct 19.
Guérin A1, Bureau ML1, Ghazali N1, Gervais R1, Liuu E1, Seité F1, Bellarbre F2, Ingrand P3,4, Paccalin M5.
1 Pôle de Gériatrie, CHU La Milétrie, 86021, Poitiers Cedex, France.
2 Pôle de Gériatrie, CHU La Milétrie, 86021, Poitiers Cedex, France. fabienne.bellarbre@chu-poitiers.fr.
3 Pôle Biologie, Pharmacie et Santé Publique, Centre Hospitalier Universitaire de Poitiers, Université de Poitiers, Poitiers, France.
4 INSERM, CIC-P 1402, Centre Hospitalier Universitaire de Poitiers, Poitiers, France.
5 Pôle de Gériatrie, CHU La Milétrie, 86021, Poitiers Cedex, France. m.paccalin@chu-poitiers.fr.

OBJECTIVE: To assess the factors associated with orthostatic hypotension (OH) in hospitalized elderly patients.

DESIGN: Prospective observational single center study.

SETTING: A French academic center.

PARTICIPANTS: One hundred and thirty-one patients without OH symptoms who underwent OH testing.

MEASUREMENTS:
The OH test was performed when the patient was able to get out of the bed and was no longer receiving parenteral fluids. The blood pressure was measured after a 10-min rest while the patients were sitting and then standing at 1 and 3 min. Demographic data, co-morbidities, current medications and biological parameters were recorded.

RESULTS:
The mean patient age was 84.3 ± 7 years. The mean CIRS-G score was 10.6 ± 3.8. The OH test was performed 6.3 ± 3.9 days after admission and was positive in 39 (29.8 %) patients (95 % confidence interval (CI) 22, 38) and positive at 1 min in 87.2 % of the cases. Multivariate analysis showed that OH prevalence correlated with diabetes (odds ratio (OR) = 4.23; 95 % CI 1.10, 16.24; P = 0.03), serum 25-hydroxyvitamin D <20 ng/ml (OR = 3.38; 95 % CI 1.36, 8.42; P = 0.008), use of tranquilizers (anxiolytic and hypnotic) (OR = 2.96; 95 % CI 1.18, 7.4; P = 0.02), CIRS-G score (OR = 1.15; 95 % CI 1.01, 1.31; P = 0.03) and lack of diuretics (OR = 0.20; 95 % CI 0.06, 0.63; P = 0.005).

CONCLUSION:
In older adults, OH is often misdiagnosed because it is asymptomatic. As practitioners may be reluctant to perform the OH test because of time constraints, targeting a subgroup of patients with a higher risk of OH should be worthwhile to prevent further OH complications.

PMID: 26482745 DOI: 10.1007/s40520-015-0451-z

Orthostatic hypotension 2X more likely if low vitamin D - meta-analysis March 2016

Hypovitaminosis D and orthostatic hypotension: a systematic review and meta-analysis.
J Hypertens. 2016 Mar 28. https://doi.org/10.1097/HJH.0000000000000907
Ometto F1, Stubbs B, Annweiler C, Duval GT, Jang W, Kim HT, McCarroll K, Cunningham C, Soysal P, Isik AT, Luchini C, Solmi M, Sergi G, Manzato E, Veronese N.

OBJECTIVES:
Orthostatic hypotension is a common condition among older adults and is associated with a range of deleterious outcomes. Recently, interest has developed in hypovitaminosis D (defined as low 25 hydroxiyvitamin D levels) as a potential risk factor for orthostatic hypotension. We conducted a systematic review and meta-analysis examining the association of orthostatic hypotension between study participants with and without hypovitaminosis D, including the adjustment of potential confounders (age, sex, BMI, renal function, comorbidities, seasonality, use of antihypertensive medications, and supplementation with cholecalciferol).

METHODS:
A systematic literature search of major electronic databases from inception until 09/2015 was made for articles providing data on orthostatic hypotension and hypovitaminosis D. A random effects meta-analysis of cross-sectional studies investigating orthostatic hypotension prevalence comparing participants with vs. those without hypovitaminosis D was undertaken, calculating the odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS:
Of 317 initial hits, five cross-sectional studies were meta-analysed including 3646 participants (1270 with hypovitaminosis D and 2376 without). The participants with hypovitaminosis D had a higher prevalence of orthostatic hypotension (OR = 1.88; 95% CI: 1.25-2.84; I = 68%) that was not affected by adjusting for a median of five potential confounders (OR = 2.03; 95% CI: 1.13-3.68; I = 73%). People with orthostatic hypotension had significantly reduced serum vitamin D concentrations (standardized mean difference = -0.42; 95% CI: -0.72 to -0.12). One longitudinal study confirmed the association between hypovitaminosis D and orthostatic hypotension.

CONCLUSION:
Our meta-analysis highlights that hypovitaminosis D is associated with orthostatic hypotension, independent of potential confounders. Further longitudinal studies and clinical trials are required to confirm these findings.

Vitamin D Deficiency and Incident Onset of Orthostatic Hypotension in Older Adults: Preliminary Results from the ‘MERE’ Study - June 2015

Journal of the American Geriatrics Society. Volume 63, Issue 6, pages 1245–1247, June 2015, DOI: 10.1111/jgs.13504
Guillaume T. Duval MD1, Antoine Brangier MD1, Jean Barré MD1, Cyrille P. Launay MD, MS1, Olivier Beauchet MD, PhD1,2 and Cedric Annweiler MD, PhD1,2,3

Publisher rents PDF for $6

Orthostatic hypotension 3.4 X more likely in elderly if low Vitamin D - Sept 2014

Vitamin D deficiency is associated with orthostatic hypotension in oldest-old women
J Intern Med. 2014 Sep;276(3):285-95. doi: 10.1111/joim.12201. Epub 2014 Apr 22.
Annweiler C1, Schott AM, Rolland Y, Beauchet O.

OBJECTIVES: Orthostatic hypotension, a condition that mostly affects 'oldest-old' (i.e. ≥80 years) adults, is primarily explained by age-related dysfunction of blood pressure control. Vitamin D may contribute to blood pressure control. The aim of this study was to determine whether vitamin D deficiency is associated with orthostatic hypotension in oldest-old adults.

DESIGN: Cross-sectional analysis at baseline of the EPIDOS study.

SETTING: Five French areas.

PARTICIPANTS: A total of 329 community-dwelling oldest-old women (mean age 83.3 ± 0.2 years).

MAIN OUTCOMES MEASURES:
Orthostatic hypotension was defined as a systolic blood pressure drop of ≥20 mmHg and/or a diastolic blood pressure drop of ≥10 mmHg within 3 min of standing. Vitamin D deficiency was defined as a serum 25-hydroxyvitamin D (25OHD) concentration ≤10 ng mL(-1) . Covariates included in the models were age, body mass index, diabetes mellitus, supine mean arterial pressure, number of drugs taken per day, use of antihypertensive or psychoactive drugs, cognition, quadriceps strength, current smoking, alcohol consumption, serum concentrations of parathyroid hormone, calcium and creatinine and season of testing.

RESULTS:
Diastolic orthostatic hypotension was observed more often among women with vitamin D deficiency (19.2%) compared to those without (10.0%; P = 0.03). There was an inverse linear association between 25OHD concentration and change in diastolic blood pressure after 3 min of standing (adjusted β = -0.07, P = 0.046). Similarly, 25OHD deficiency was associated with orthostatic hypotension [adjusted odds ratio (OR) 3.36, P = 0.004], specifically with diastolic orthostatic hypotension (adjusted OR 3.81, P = 0.003).

CONCLUSIONS:
25OHD deficiency was associated with orthostatic hypotension in oldest-old women, due to a greater drop in diastolic blood pressure on standing. This finding may lead to better understanding of the pathophysiology of falls in oldest-old adults with vitamin D deficiency.

PMID: 24444004 DOI: 10.1111/joim.12201

See also VitaminDWiki

See also web

There have been 3198 visits to this page

1506 visitors, last modified 12 Mar, 2024,
Printer Friendly Follow this page for updates